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� <br /> APPLICATION FOR SANITATION PERMIT RannitNu <br /> (Complete in <br /> Duplicate) Dote Issued <br /> Application is hereby made to the San Joaquin Loco/ Heo|H` District for it to construct and install <br /> the work herein described. <br /> This applicat-ion is,made,in,compli6rtce with County Ordinan <br /> JOB ADDRESS AND ILO ATION--- <br /> ft - ---------- ------ ---------- <br /> Owner's Name ----4� <br /> PA� ----------------------------------------------------------------------- ------------------------ <br /> Installation will serve: Residence X Apartment House El Commercial El Trailer Court E] Motel El Other Ej <br /> Number of living units. J---- Number of bedrooms 3�Number of baths Lot size <br /> e 9, Depth to Water Table ft. <br /> Water Supply: Public system El Community system Ej Privat <br /> Character of soil to a depth of 3 feet: Sand E] Gravel Ej Sandy Loam E] Clay Loam [-] Clay El Adobe Hardpan <br /> Previous Application Made: Yes Ej No 1-111 New Construction: Ye No E] FHA/VA: Yes E-] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tan� or'cesspool permitted if public sewer is available within 200 feet.) <br /> well- Distance f7rokunda­fion___'_j_1) M <br /> Sept it,Tank: Distance from nearest <br /> No. of compartments _,0 <br /> D'x jd <br /> iwal Fie Distance from nearest well-"- . -Distance from foundation----1.0---------Distance to nearest lot line--- <br /> Type of filter material---57)_-ffl'C40epth of filter material----/ Z' I <br /> Seepage Pit; Distance to nearest well-------------- --..'--Distance from.-foundation <br /> nem000/mg and/or repu/nng |dr,c,iue):-/ --. '����«������������.. --------------------------- � <br /> -- V ' ~-� �- <br /> - - --.-_.--'-_-_-.._----__-___.----.__-__---_._-.—.. <br /> --'----_''---.-''-_'-_-'-_----.''-_--_--_-__--___'_--'_-.-_.'__.''-''�_-'-'_---'--he ^ <br /> San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />^ (Si ~ <br /> By: -------------------- ._-_-._--._-_._.__---_--_--_- ".=)-.__-__-_-' <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY Y. <br /> APPLICATION ACCEPTED 8Y_''-�-''-''� �--'—�'-''—_-�__'-_.''-_-'-_ DATE------ ' <br /> REY|EV�B} BY ---------' � <br /> ""'LD"``= '"`"".. ISSUED' ' <br /> Alterations <br /> laf <br /> ' ----_--'-''''---�- ~`'-_.''__,-_.'''-__'__'__.--''__--'---___-'-- ' <br /> ----------------------------------------------------------------------------------- --------------------------- . <br /> ------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------'------------------- ' ( <br /> --------------------------------- ------------- ------------------------------------------------------ -----------------------------''--'-''-'-''--.--- <br /> —.--------�---_--._. . . <br /> -,---'''--'_''''-''--��'''-''--'---'-'--''-'''- � <br /> FIN/\L /NSPBCT|ON 8Y:---.— -���'�°�'. Dote-------------------- <br /> SAN <br /> --_--_SAN JOAQUUNLOCAL HEALTH DISTRICT ) <br /> /sn South American Street 300 West Oak Street 1:2 Sycamore Street u/* w"*h ^C^ Street <br /> Stockton. California Lodi. California Manteca, California Tracy, California <br /> ps--9-2w . Revised 1.57 r,n.oz ' <br /> . . 1 <br />